ATTACHMENT G CONTRACTOR CERTIFICATION.docx
DOCX document 17 KB Posted
- Attached to
- Home Sleep Apnea Testing Service
- Solicitation number
- 36C25626Q0736-1
About this file
This is a Contractor Certification form required for the Home Sleep Apnea Testing (HSAT) Service contract (Solicitation 36C25626Q0736-1) with the Department of Veterans Affairs Veterans Health Administration, Veterans Integrated Service Network 16 (Gulf Coast Veterans Health Care System in Biloxi, MS).
The certification document requires the contractor to certify compliance with the Immigration and Nationality Act of 1952 and related federal laws enforced by Homeland Security, Immigration and Customs Enforcement, and the U.S. Department of Labor. The contractor must commit to not knowingly employ, contract, or subcontract with illegal aliens or foreign nationals whose immigration status is in violation. The contractor must also ensure that all subcontractors provide similar certifications. Non-compliance may result in prohibition of non-compliant foreign nationals from working at the contractor's facilities serving VA patient referrals and may constitute grounds for contract termination for breach. The form requires signature, date, typed name and title, and company name from an authorized representative, with a statement that false certification may result in prosecution under 18 U.S.C. § 1001.
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Text version
ATTACHMENT G - CONTRACTOR CERTIFICATION
36C25626Q0736
CONTRACTOR CERTIFICATION
The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;
While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.
If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.
The Contractor agrees to obtain a similar certification from its subcontractors.
| Signature: | ____________________________________________ |
| Date: | ____________________________________________ |
Typed Name and Title: ___________________________________ Company Name: ______________________________________ This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.
File details come from the government source that posted it. Updated .